Effects
of Variations in Caregiving on Cognitive Functioning and Behavior
Problems in a U.S. National Sample of NeurodevelopmentallyAt-risk
Children

Neurodevelopmental
impairment is a risk factor for later cognitive functioning
and behavior problems. However, subsequent caregiving may
also affect outcomes for at-risk children. Sara R. Jaffee
(2007) tested the hypothesis that sensitive, stimulating caregiving
would improve outcomes in a U.S. national sample of 1720 at-risk
children. She did this by analyzing predictive associations
between initial neurodevelopmental scores and scores for caregivers'
cognitive stimulation and emotional support at ages 3 to 24
months and scores on these same variables, plus scores on
a language scale and CBCL Total Problems 18 months later.
All the children had been referred to child protective services
for investigation of abuse or neglect. Baseline neurodevelopmental
risk and difficult temperament both predicted lower language
scores and higher CBCL problem scores 18 months later. Furthermore,
improvements in cognitive stimulation and increases in family
income significantly predicted improvements on the language
measure. Jaffee also compared 18-month outcomes for 49 children
who were initially living with their biological parents but
were removed from their parents during the 18 months versus
769 children who remained with their biological parents for
the 18 months. A significant interaction with removal from
the biological parents revealed that the combination of removal
and improved cognitive stimulation was followed by higher
language scores, whereas removal and decreased stimulation
were followed by lower language scores than were found following
changes in cognitive stimulation among children who were not
removed. Improvements in emotional support tended to be followed
by lower CBCL problem scores. Like the effect of removal on
language scores, there was also a tendency for effects of
changes in emotional support to be accentuated by removal
from biological parents. In light of disagreements about the
potential harm versus benefits of removing children from abusive
or neglectful parents, the finding that removal appeared to
benefit children only when caregiving improved is especially
important: ". . . benefits only accrued to children who
experienced improvements in the quality of the caregiving
they received. When the quality of caregiving they received
worsened, they showed poorer (or as poor) functioning compared
with children who remained in the care of biological parents"
(p. 643).